1 My WRAP Plan Mary Ellen Copeland, MS, MA All Rights Reserved P.O. Box 301, West Dummerston, VT Copeland Center for Wellness & Recovery P.O. Box 6464, Chandler, AZ (866) (toll-free) (480) (480) (fax) copelandcenter.com
3 Personal Information This Wellness Recovery Action Plan belongs to: Name Address City State Zip Telephone Special instructions
5 1 What is WRAP? WRAP stands for Wellness Recovery Action Plan WRAP is a self-management and recovery system developed by a group of people who had mental health difficulties and who were struggling to incorporate wellness tools and strategies into their lives. WRAP is designed to: Decrease and prevent intrusive or troubling feelings and behaviors Increase personal empowerment Improve quality of life Assist people in achieving their own life goals and dreams. WRAP is a structured system to monitor uncomfortable and distressing symptoms that can help you reduce, modify or eliminate those symptoms by using planned responses. This includes plans for how you want others to respond when symptoms have made it impossible for you to continue to make decisions, take care of yourself or keep yourself safe. People who are using WRAP say: It helps me feel prepared. I feel better more often and I m able to improve the overall quality of my life. The person who experiences symptoms is the one who develops their personal WRAP. The person may choose to have supporters and health care professionals help them create their WRAP. The WRAP system was developed by people who have been dealing with a variety of psychiatric symptoms for many years and who are working hard to feel better and get on with their lives. Mary Ellen Copeland has shared it with people with other illnesses and they too believe that it can be easily adapted for use with other conditions. Reprinted from
6 2 What People are Saying About WRAP... "Recovery & WRAP have changed my life." "I've gone from being totally disabled to being able to live a full and rich life. I am so grateful." "Everything has improved at our organization. People are recovering and moving forward with their lives. Our work is so much more fulfilling." Finally, something I can do to help myself. I used to spend months, even years, in the hospital. Now I have a bad afternoon or a bad day. And it's all because I use WRAP. WRAP for me is about personal responsibility. I can just let my "symptoms" take over my life. Or I can take personal responsibility, use my WRAP, and do what I need to do to take care of myself and feel better. In the years that I have been using WRAP, everything has changed in my life. I used to spend all my time just sitting around, watching TV and smoking. Now I hardly ever watch TV, I've given up smoking, I've gone back to school and I have a real job. And I have a wonderful partner. I never thought life could be this good. This has changed my life completely. I used to think of myself as this "mentally ill" person. Now I am a person who knows how to take care of myself and help myself in difficult time. If I am feeling badly or having a hard time, I take action. And there are so many simple, safe things I can do. When I was feeling badly I used to call the doctor or call the hotline. Now I check my list of Wellness Tools and do something I really enjoy. Usually its call a friend to go for a walk, go to a movie, watch a video or just talk. The word crisis has a different meaning for me now. I used to think it was a crisis when I felt really anxious and upset. I thought I needed to go into the hospital or get my medications increased. Now a crisis is when everything is so bad I need others to take over for me. And I don't have them anymore, because now I know how to take care of myself. Reprinted from
7 3 WRAP: The Wellness Recovery Action Plan by Mary Ellen Copeland, MA, MS WRAP is a self-designed plan for staying well and for helping you to feel better when you are not feeling well to increase personal responsibility and improving your quality of life. The first part of WRAP is developing a personal Wellness Toolbox. This is a list of resources you can use to develop your WRAP. It includes things like contacting friends and supporters, peer counseling, focusing exercises, relaxation and stress reduction exercises, journaling, creative, fun and affirming activity, exercise, diet, light, and getting a good night's sleep. Section 1 of WRAP is the Daily Maintenance Plan. It includes three parts: 1.) a description of yourself when you are well, 2.) those Wellness Tools you know you must use every day to maintain your wellness, and 3.) a list of things you might need on any day. Section 2 is identifying those events or Triggers that, if they happened, might make you feel worse--like an argument with a friend or getting a big bill. Then, using Wellness Tools, you develop an action plan you can use to get through this difficult time. Section 3 is identifying Early Warning Signs, those subtle signs that let you know you are beginning to feel worse, like being unable to sleep or feelings of nervousness. Then, again, using your Wellness Toolbox, developing an action plan for responding to these signs you feel better quickly and prevent a possible difficult time. Section 4 is When Things are Breaking Down. In this section, you list those signs that let you know you are feeling much worse, like you are feeling very sad all the time or are hearing voices. And again, using your Wellness Toolbox, develop a powerful action plan that you that will help you feel better as quickly as possible and prevent an even more difficult time. Section 5 is a Crisis Plan or Advance Directive. In the crisis plan, you identify those signs that let others know they need to take over responsibility for your care and decision making, who you want to take over for you and support you through this time, health care information, a plan for staying at home through this time, things others can do that would help and things they might choose to do that would not be helpful. This kind of proactive advanced planning keeps you in control even when it seems like things are out of control. Section 6 is the Post Crisis Plan. You may want to think about this part of the plan in advance and even write some things to do in that time. However, you may want to write most of it as you
8 4 are beginning to recover from the crisis when you have a clearer picture of what you need to do for yourself to get well. Review your plans every day, noting how you feel and doing what you need to do to help yourself get better or to keep yourself well..as you become familiar with your plan, you will find that the review process takes less time and that you will know how to respond without even referring to the book. People who are using these plans regularly and updating them as necessary are finding that they have fewer difficult times, and that when they do have a hard time it is not as bad as it used to be and it doesn t last as long. The WRAP approach empowers you to take control of your own health and wellness. Since its development, the system has been shared with thousands of people through the books Wellness Recovery Action Plan and Winning Against Relapse, the Winning Against Relapse audio tape, the Creating Wellness video series, numerous support groups, workshops and seminars, and through the web site. Copeland Center for Wellness & Recovery P.O. Box 6464 Chandler, Arizona (866) (toll-free) (480) (480) (fax)
9 5 How to Use the WRAP Program Reprinted from Wellness Recovery Action Plan by Mary Ellen Copeland, MS, MA Published by Peach Press In order to use this program successfully, you have to be willing to spend up to 15 or 20 minutes daily reviewing the pages, and be willing to take action if indicated. Most people report that morning, either before or after breakfast, is the best time to review the book. As you become familiar with your symptoms and plans, you will find that the review process takes less time and that you will know how to respond to certain symptoms without even referring to the book. Begin with the first page in Section 1, Daily Maintenance Plan. Review the list of how you are if you are all right. If you are all right, do the things on your list of things you need to do every day to keep yourself well. Also refer to the page of things you may need to do to see if anything rings a bell with you. If it does, make a note to yourself to include it in your day. If you are not feeling all right, review the other sections to see where the symptoms you are experiencing fit it. Then follow the action play you have designed. For instance, if you feel very anxious because you got a big bill in the mail or had an argument with your spouse, follow the plan in the triggers section. If you noticed some early warning signs (subtle signs that your symptoms might be worsening) like forgetting things or avoiding answering the phone, follow the play you designed for the early warning signs section. If you notice symptoms that indicate things are breaking down, like you are starting to spend excessive amounts of money, chain smoking or have more intense pain, follow the play you developed for when things are breaking down. If you are in a crisis situation, the book will help you discover that so you can let your supporters know they need you to take over. However, in certain crisis situations, you may not be aware or willing to admit that you are in crisis. This is why having a strong team of supporters is so important. They will observe the symptoms you have reported and take over responsibility for your care, whether or not you are willing to admit you are in a crisis at that time. Distributing your crisis plan to your supporters and discussing it with them is absolutely essential to your safety and well-being. If you have just been through a crisis, refer to your post crisis plan to guide you as you heal from this difficult time. When you feel you are ready, you can return to using the other parts of your Wellness Recovery Action Plan as you did before the crisis.
11 7 Wellness Toolbox List any tools you have learned, either from this class or from your own life experience. List things that you would like to try, even if you haven t already. Then keep adding new ones &/or crossing out ones you decide aren t right for you. Keep this list in a prominent place so you can refer to it often.
12 8 My Notes & Ideas
13 9 Building My Daily Maintenance Lists 1. On the first page of this section, make a list of things that describe you when you re feeling well. This will include what you are like when you re feeling happy & doing well Make Next, list what you absolutely need to do each day in order to stay well. You may find it helpful to create a schedule of your daily routine. a reminder list for things you might need to do. These things don t need to be done every day, but they could be helpful in keeping you well. Looking at this list each day can help you stay on track & avoid the stress caused by forgetting if or when they need to be done. 4. Finally, list the things you want to do weekly &/or monthly.
14 10 Building My Daily Maintenance Lists You may have discovered certain things you need to do every day to maintain your wellness. This plan helps you recognize those things which you need to do to remain healthy, and then plan your days accordingly. When you are starting to feel out of sorts, you can often trace it back to not doing something on your Daily Maintenance List. This is how I am when I am feeling good (or how I d like to be when I m feeling well). These are the things I know I need to do for myself EVERYDAY to make sure I stay well. These are the things I need to do WEEKLY to make sure I stay well:
15 11 Building My Daily Maintenance Lists, cont. These are the things I need to do MONTHLY to make sure I stay well: These are the things I need to do PERIODICALLY to make sure I stay well: I can do these special little things for myself when I need to feel better.
16 12 My Notes & Ideas
17 13 Identifying My Triggers Triggers are external events or circumstances that may make you feel like you are getting ill. These are normal reactions to life events but, if you don t respond to them, they may actually make you feel worse. The awareness of triggering events will increase your ability to cope and to avoid the development of an onset of more severe symptoms. 1. On 2. Then, the next page, make a list of the life stressors that are likely to trigger your symptoms. This might include such things as events, activities, people, places, anniversaries, work, & other situations. develop a plan to cope with your triggers when they do occur. Pay close attention to your daily maintenance list. You might also want to make plans to call family &/or friends for more support or use more of your things from your wellness toolbox.
18 14 Identifying My Triggers These are the things that may happen to cause an increase in my symptoms. If any of the following things come up, I will do some of the activities listed to help keep my symptoms from getting worse. If any of my triggers come up, I will do of the following things:
19 15 Identifying My Triggers, cont. Some of these activities might also be helpful:
20 16 My Notes & Ideas
21 17 Looking for My Early Warning Signs 1. On 2. On the first page of this section, list some of the subtle thoughts, feelings, sensations, & behaviors that you tend to experience when you are first starting to have a problem. These may or may not be related to any specific situation. Be sure to ask your friends, family, or professionals for early warning signs they have noticed. the next pages, list what you will do to respond to your early warning signs. Be sure to make good use of your wellness toolbox. You may also look at cutting back on some of the non-essential things you are doing.
22 18 Looking for My Early Warning Signs This is a list of my early warning signs: These are the things I MUST do:
23 19 Looking for My Early Warning Signs, cont. These are the things I COULD choose to do if they feel right to me:
24 20 My Notes & Ideas
25 21 When Things are Breaking Down or Getting Worse You may begin to feel even worse very uncomfortable, like the situation is serious and even dangerous but you are still able to take some action in your own behalf. This is a very important time. It is necessary to take immediate, assertive action to prevent a crisis. 1. On 2. On the first page, write out a list of any signs, symptoms, & circumstances that would show you that things are breaking down. Some of these may be early warning signs that are more intense the next page, write out a plan that you think will help to reduce your signs & symptoms when they have reached this point. Your plan needs to be clear & specific. You may re-list previous tools & strategies, but you may need to do them more often &/or for longer periods of time. Focusing on more intense support, getting more rest and better stress management is often necessary.
26 22 When Things are Breaking Down or Getting Worse Symptoms that, for me, mean that things have gotten worse & are close to the crisis stage: If the previous symptoms come up, I need to do ALL of the following things:
27 23 When Things are Breaking Down or Getting Worse These are things that might also help: These are questions I may need to ask myself:
28 24 My Notes & Ideas
29 25 My Crisis Plan In spite of your best planning & assertive action, you may find yourself in a crisis situation where others will need to take over responsibility for your care. You may feel as though you are totally out of control. Your crisis plan will instruct others about how to care for you when you are not well. It keeps you in control even when it seems like things are out of control. Others will know what to do, saving everyone time & frustration, while insuring that your needs will be met. 1. On the first page of this section, make a list of the words that describe you when you are feeling well, in case you need to avoid emergency responders misinterpreting what is going on with you Describe 6. Finally, Next, make a list of things that will let others know that you are in a crisis & that you need them to take over for you. Be very clear & specific. List the people you want to take over if the things you described occur. Next, list any health care professionals or family members that you do NOT want involved. how disputes or differences of opinion regarding what you have written in your plan should be settled (for example, majority rules, one person has final say, etc.). write out a list of preferred, acceptable medications to be used in case of a crisis as well as medications that are unacceptable & why. Include the name, dosage, & purpose of your preferred & acceptable medications. Name a person & the method you want used to evaluate previously untried or unstudied medications.
30 26 My Crisis Plan: Part #1 What I m Like when I m Feeling Well This is what I m like when I m feeling well: My Crisis Plan: Part # 2 My Symptoms These are the symptoms or behaviors that indicate to others that I need them to take over responsibility for my care & make decisions on my behalf.
31 27 My Crisis Plan: Part # 3 People to Take Over I would like the following people to take over for me when the symptoms or behaviors listed on the previous page become obvious. Person s Name Connection, role, or relationship to me Phone Number If there are disputes between my supporters, the following is how I would like the situation handled:
32 28 My Crisis Plan: Part # 3, cont. People I Don t Want Involved I would like for the following health care providers, family members, or friends to NOT BE INVOLVED IN ANY WAY in my care or treatment. Person s Name Connection, role, or relationship to me Reason for no involvement
33 29 My Crisis Plan: Part # 4 Medications These are the medications that I am currently taking: Name of Medication Dosage What I Take This Medication For These are the medications that I would prefer to take if medications or additional medications become necessary. Name of Medication Dosage What I Take This Medication For
34 30 My Crisis Plan: Part # 4, cont. Medications These medications would be acceptable to me if medications became necessary. Name of Medication Dosage What I Take This Medication For These are the medications that must be avoided: Name of Medication Dosage Why I Want to Avoid This Medication
35 31 My Crisis Plan: Part # 5 Treatments These treatments may help reduce my symptoms. Treatments That May Help Me When These Treatments Should Be Used These are treatments I want to avoid. Treatments to Avoid Why These Treatments Should Be Avoided
36 32 My Crisis Plan: Part # 6 Staying in the Community This is my plan so that I can stay at home or in the community and still get the care that I need. Service or Help That I Desire By Whom Other Details
37 33 My Crisis Plan: Part # 7 Treatment Facilities These are the facilities that I prefer to be treated or hospitalized at if that becomes necessary. Name of Facility Location Other Details These are the treatment facilities that I want to avoid. Name of Facility Location Other Details
38 34 My Crisis Plan: Part # 8 Things Others Can Do for Me These are the things that other people can do for me that would help to reduce my symptoms & make me more comfortable. These are the other tasks that I need others to do for me. What I Need Done Who I d Like to Do It
39 35 My Crisis Plan: Part # 8, cont. Things That Wouldn t Help These are things that others might do, or have done in the past, that would NOT help. They might even worsen my symptoms.
40 36 My Crisis Plan: Part # 9 Inactivating the Plan These are a description of my symptoms, lack of symptoms or actions that indicate my supporters no longer need to use this plan.
41 37 My Crisis Plan: Part # 10 If I am in Danger If my behavior endangers me or others, I want my supporter/s to do the following:
42 38 Signatures You can help assure that your crisis plan will be followed by signing it in the presence of two witnesses. It will further increase its potential for use if you appoint and name an agent to act on your behalf a durable power of attorney. NOTE: Any plan with a more recent date supersedes this one. I, developed this plan on Name Date I developed this crisis plan with the help of the following persons: Signed Witness Witness Attorney Date Date Date Date
43 39 My Notes & Ideas
44 40 Post Crisis Planning The Post Crisis Plan is different from other parts of your WRAP plan in that it is constantly changing as you heal. It is hoped that two weeks after the crisis you will be feeling much better than you did after one week, and therefore, your daily activities would be different. After you feel you are no longer in the post crisis time, you could go back to using your Daily Maintenance Plan and other parts of your WRAP. 1. First, describe how you will know when you are out of a crisis and ready to use your post crisis plan Next, list the persons who you would like to support you in this post crisis period. Include information that will help make you feel safe during this period. List the things you need to do for yourself while you are recovering from a crisis, including information on what you need to do to prevent a future crisis from occurring in the same manner. Next, list signs that indicate your post crisis phase is over, allowing you to return to your Daily Maintenance Plan and other sections of your WRAP plan. Finally, explain your timetable for resuming responsibilities for yourself.
45 41 Post Crisis Planning: Returning after a Crisis 1. I will know that I am out of crisis and ready to use this post crisis plan when I: 2. How I would like to feel when I have recovered from this crisis (You may want to refer to the first section of your WRAP: What I am Like When I am Well. This may be different from what you feel like when you are well your perspective may have changed in the crisis):
46 42 Post Crisis Planning: Post Recovery Support List I would like the following people to support me if possible during this post crisis time: Name Phone Number What I need them to do: If I am being discharged from a treatment facility, do I have a place to go that is safe & comfortable? Yes No If not, these are the things I need to do to insure that I have a safe & comfortable place to go: If I have been hospitalized, my first few hours at home are very important. Will I feel safe and be safe at home? Yes No
47 43 If my answer is no, this is what I need to do to insure that I will feel and be safe at home: I would like to take me home. or I would like to stay with me. or When I get home, I would like to or If the following things were in place, it would ease my return home: These are the things I must take care of as soon as I can:
48 44 These are the things I can ask someone else to do for me: These are things that can wait until I feel better: These are the things I need to do for myself every day while I am recovering from a crisis: These are things I might need to do every day while I am recovering from this crisis:
49 45 These are the things and people I need to avoid while I am recovering from crisis: These are signs that I may be beginning to feel worse (examples include anxiety, excessive worry, overeating, sleep disturbances, etc.): These are the wellness tools I will use if I am starting to feel worse (put a star beside those that you must do, the others are choices): These are the things I need to do to prevent further repercussions from this crisis and when I will do these things: Things I need to do When I will do these things
50 46 These are the people I need to thank: Person When I will thank them How I will thank them These are the people I need to apologize to: Person When I will apologize How I will apologize These are the people with whom I need to make amends: Person When I will make amends How I will make amends
51 47 Medical, legal or financial issues that need to be resolved: Issue How I plan to resolve this issue These are the things I need to do to prevent further loss (examples include canceling credit cards, getting official leave from work, cutting ties with destructive friends, etc.): These are signs that this post crisis is over and I can return to using my Daily Maintenance Plan as my guide to things to do for myself every day:
52 48 These are changes to my earlier WRAP plan (Daily Maintenance, Triggers, Early Warning Signs, When Things are Breaking Down) that might help prevent such a crisis in the future: These are the changes in my crisis plan that might ease my recovery: These are changes I want to make in my lifestyle or life goals: This is what I learned from this crisis:
53 49 These are the changes I want or need to make in my life as a result of what I have learned: If I want or need to make changes, this is when and how I will make these changes: When will I make changes How will I make changes
54 50 Post Crisis Planning: Resuming Responsibilities It is important to develop plans for resuming responsibilities that others may have had to take over or that did not get done while you were having a hard time. Responsibility: Who has been doing this for me? While I am resuming this responsibility, I need to: (e.g. to do everything on my Daily Maintenance Plan, ask my spouse to continue doing household chores, etc.): Responsibility: Who has been doing this for me? While I am resuming this responsibility, I need to (e.g. to do everything on my Daily Maintenance Plan, ask my spouse to continue doing household chores, etc.):
55 51 Post Crisis Planning: Resuming Responsibilities, cont. Responsibility: Who has been doing this for me? While I am resuming this responsibility, I need to: (e.g. to do everything on my Daily Maintenance Plan, ask my spouse to continue doing household chores, etc.): Responsibility: Who has been doing this for me? While I am resuming this responsibility, I need to: (e.g. to do everything on my Daily Maintenance Plan, ask my spouse to continue doing household chores, etc.):
56 52 My Notes & Ideas
57 53 My Notes & Ideas
60 Kansas WRAP Project University of Kansas School of Social Welfare Office of Mental Health Research & Training 1545 Lilac Lane Lawrence, KS (785)